Tinnitus: When your ears won't stop ringing

By: Harvard Women's Health Watch (Tuesday, 03-09-2002)

The sound of silence is not always welcome. But if you're one of the approximately 12 million Americans who suffer from persistent tinnitus (tin-NIGHT-is or TIN-it-is), you'd probably give just about anything to get relief from the noise in your ears.

What is tinnitus?

Most of us know what it's like to hear ringing in our ears — after we've been exposed to a loud noise, for instance. It's irksome while it lasts, but it eventually disappears. For tinnitus sufferers, however, the ringing (or buzzing, whistling, hissing, or rushing) doesn't go away.

Tinnitus can come on gradually or abruptly. It may last a relatively short period of time, return sporadically, or go on forever. The sound a person hears may be high- or low-pitched, loud or soft, intermittent or continuous. It can occur in one ear or in both.

In most cases, only the sufferer can hear the noise (subjective tinnitus). But sometimes a doctor can hear it (objective tinnitus) when listening to the person's neck, jaw, temple, or ear with a stethoscope.

What causes tinnitus?

Often the underlying problem is damage to the sensory (hair) cells located in the cochlea of the inner ear, or to cells along the auditory nerve, which connects the inner ear to the brain. This type of damage can come with age — one reason why a third of people over age 55 have tinnitus, compared to 20% in the total population. It can also be caused by exposure to loud noises.

Heart health may play a role. An atherosclerotic buildup of cholesterol can increase the force of blood flow in vessels near the ear, making it easier to hear the rhythmic beat of the heart. This condition is called pulsatile tinnitus.

People with neck, bite, or jaw disorders (such as damage to the temporomandibular joint, or TMJ) have a higher than average rate of tinnitus. Jaw and bite misalignment and neck problems can affect muscles and nerves near the ear. Stress, which often accompanies these conditions, makes tinnitus worse.

Other causes range from earwax buildup to acoustic neuroma, a noncancerous tumor that requires surgery. Stiffening of the bones (osteosclerosis) in the middle ear is another cause.

Tinnitus is also a side effect of many prescription and nonprescription medications (see box, below).

Should I see my doctor?

Unfortunately, much of the time, doctors can't pinpoint the cause. But if you're taking any medications that cause or exacerbate tinnitus, your clinician can advise you about alternatives and write new prescriptions. She or he can also help identify problems such as earwax buildup or ear infections. If your tinnitus has no obvious cause, your doctor can refer you to an ear, nose, and throat specialist (otolaryngologist) for a detailed exam and hearing test.

In the majority of cases in which no cause is found, the main treatment is counseling. Stress reduction, relaxation, and other behavioral techniques can often help people cope with their symptoms.

How to manage tinnitus

Medications rarely help tinnitus, although certain tranquilizers and antidepressants may help in coping with the distress it can cause. But there are several ways to reduce the noise or learn to live with it.

Hearing aids. If you have hearing loss and tinnitus, a hearing aid will allow you to hear more environmental sounds, which can help block out tinnitus noise.

Cochlear implants. These surgically implanted devices, prescribed only for patients with little or no hearing, have been reported to help with tinnitus. A surgeon inserts a set of electrodes into the cochlea and implants a receiver in the skull behind the ear. Together with a microphone, speech processor, and transmitter, these devices pick up sounds and send signals to the brain. Why cochlear implants work for tinnitus isn't clear. They may bring in sounds that mask tinnitus, or they may electrically stimulate the auditory nerve to suppress it.

Masking. Tabletop machines that create external white noise (an even "shh" sound) can help mask internally generated tinnitus noise. Keeping a television or radio on in the background serves the same purpose. Specially made masking units can be worn like hearing aids. Tinnitus instruments combine a hearing aid with a masker.

Tinnitus retraining therapy. A counselor can help you train your brain to ignore the ringing by exposing you to constant low-level sounds. But this may take up to two years.

Biofeedback. This method teaches you how to control your physiological response to stress and prevent it from making your tinnitus worse.

Complementary and alternative therapies

Many European doctors and a growing number of doctors in the United States use ginkgo biloba to treat tinnitus. Although its effects are unproven, a few good trials suggest that the herb may lower the perceived loudness of patients' tinnitus. The recommended dose is 40 mg three times a day (with meals) of a preparation labeled 24% ginkgo biloba or "standardized extract."

Hypnotherapy and relaxation techniques may also offer modest benefits.

The importance of reducing stress

For some, coping with tinnitus is a matter of mind over matter. We focus more on stressful stimuli like tinnitus when we're tense or anxious. Therefore, stress reduction (sometimes taught as an adjunct to biofeedback) may give you some relief.

Stress reducers include:

Thirty minutes per day of moderate physical activity, such as a brisk walk. Regular exercise helps relieve tinnitus not only by combating stress but also by improving circulation.

Meditation. Focused concentration (including the Relaxation Response — see box at left — developed by Dr. Herbert Benson at Harvard Medical School) can help direct your attention away from the noise in your head. It can also help lower blood pressure and reduce muscle tension.

Self-help groups. Meeting others with the same problem may reduce stress and make you feel less alone. (See "Selected Resources" to find an organization that can direct you to a group near you.)

Tips for coping with tinnitus

• Carry a pair of earplugs in your purse or briefcase and wear them if you're going to be around loud noises.
• If your tinnitus seems to get worse in certain environments, make them "tinnitus friendly" by introducing a benign background sound, such as low music.
• If your tinnitus fluctuates in intensity from day to day, keep a list of what you eat and drink and note your symptoms. This may help you identify foods or beverages that trigger or worsen your tinnitus symptoms.
• Follow a heart-healthy diet, which can reduce your risk for hypertension and circulation problems. Impaired blood flow to vessels in and around the ears can exacerbate tinnitus.

Selected Resources

American Tinnitus Association
P.O. Box 5, Portland, OR 97207
(800) 634-8978
www.ata.org

American Academy of Otolaryngology — Head and Neck Surgery
1 Prince St., Alexandria, VA 22314
(703) 836-4444
www.entnet.org

American Academy of Audiology
8300 Greensboro Dr., Suite 750, McLean, VA 22102
(800) 222-2336
www.audiology.org

American Speech-Language-Hearing Association
10801 Rockville Pike, Rockville, MD 20852
(800) 638-8255
www.asha.org